Abstract: Objective To investigate the association between shift scheduling patterns and occupational injuries among healthcare professionals, and to analyze the moderating effects of department-level factors on this association. Methods A multicenter cross-sectional study design was employed. In May 2025, 630 healthcare professionals from three tertiary Grade-A hospitals in Xi'an were recruited as the study population. Data were collected via questionnaire surveys. A two-level logistic regression model (with individuals as Level 1 and departments as Level 2) was constructed to analyze the correlation between shift scheduling patterns and the incidence of occupational injuries. Results A total of 600 valid questionnaires were retrieved, yielding an effective response rate of 95.24%. The overall prevalence of occupational injuries was 82.17% (493/600), with distribution rates of 78.02% (181/232) in internal medicine, 80.93% (157/194) in surgery, 88.89% (96/108) in the emergency department (ED), and 89.39% (59/66) in the intensive care unit (ICU). Internal medicine predominantly utilized regular day shifts; surgery primarily employed regular day and two-shift systems; whereas the ED and ICU mainly implemented two-shift and three-shift systems. Multilevel logistic regression analysis revealed that, after controlling for confounding variables, the risk of occupational injury was significantly higher in surgery (OR=1.972), the ED (OR=2.254), and the ICU (OR=2.375) compared to internal medicine (P<0.05). A bed-to-nurse ratio of <1∶0.4 (OR=4.873, P<0.05) was also associated with an elevated injury risk. Furthermore, compared to regular day shifts, the two-shift system (OR=2.023), three-shift system (OR=1.988), ≥9 night shifts per month (OR=2.777), average weekly working hours >40 h (OR=2.389), and overtime frequency of ≥2 times per week (OR=2.607) emerged as independent correlates of occupational injuries (all P<0.05). Following the inclusion of fixed effects, the residual variance of the random intercept at the department level decreased to 0.208 (P=0.035). Conclusion Occupational injuries among healthcare professionals exhibit pronounced individual heterogeneity and departmental clustering. Suboptimal shift scheduling patterns are significantly associated with an elevated risk of occupational injury, and the magnitude of this association is moderated by department typology.

Key words: Healthcare workers, Occupational injuries, Shift scheduling, Departments, Association, Multilevel model